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tv   Politics and Public Policy Today  CSPAN  January 29, 2016 1:00pm-3:01pm EST

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inaccurate reason. it's that he was demoted because for an improper purpose. the perception that he was engaging in protected first amendment activity. >> you brought up in your brief, i think, that the employer might have had a policy, i think you said we should re-man to determine whether this employer said nobody engages in political activity. >> well, i think if you for the petitioner here there would be a remand any way. >> is it based in the facts up to now did you think there was such a policy? >> well, so there is i think a factual dispute about this. so if you look at the summary judgment filings, this is document number 189 on pacer, there are in the respondent statement of undisputed facts some assertion that this was in fact a neutrality policy. you definitely have a dispute coming back from the other side petitioner says nobody knew about that policy.
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so we think that is one thing potentially lower courts would have to look at and resolve the dispute in that sense. but i do want to get back to another concern that i think respondent's position raises. we do think that petitioner has his own first amendment right here that was violated. we do think when an employer acts against an employee based on a mistaken perception of his beliefs, that creates exactly the same chilling effect with which the elrod cases are concerned. the other employees will know that the employer expects political orthodoxy and will be chilled in their own association as a result. i think there's another concern here that deepens the chilling effect. and that is that the logic of respondent's position applies not only in mistaken but also in cases which the employer acts to exploit a loophole, imagine a situation in which the employer knows some people have engaged in political affiliation, the employer wants to send a message and does that by acti ining aga
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the employee, so i think that is one of the dangers of respondent's rule here that it will create a loophole. and so what we are saying essentially is that this is just a narrow corollary to the elrod right that the court has already recognized when the employer acts with the exact same intent that is already impermissible under elrod and injures the employee in his employment as a result the employer should be equally liable. it shouldn't get a free pass simply because it's both ill motivated and wrong. >> thank you, counsel. mr. goldstein. >> mr. chief justice, and may it please the court, the doctrinal fight in the briefing is over whether the plaintiff in a case like this has to assert a constitutional right. and i think the questions so far have indicated an understanding that the plaintiff would have to. and the real question is then is there actually a constitutional right here, one that we might define in other terms including the one that justice kennedy
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identified as the right not to have your political views inquired in. and this is actually discussed in the court's opinion in o'hare in describing elrod and branty. i want to start there. we have to recognize this right has never been recognized in any other political association case whatsoever. and there's no logical reason why it would occur specifically in the public employment context, which is an unconstitutional -- >> can you explain, mr. goldstein, what sense it would make there are two people -- for example, mr. frost, one of them is a big supporter of spaniola, and he gets demoted, and the other is politically neutral, and he gets demoted because the employer thinks he's a supporter of the rival mayoral candidate. how could you make sense to a person of ordinary reason that one of them, the one who was in fact engaging in political activity can't be demoted but
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the other one who just was innocent didn't do anything? >> okay. i have to focus on really the precise wording of your hypothetical, but i think you may have something slightly different in mind. you identified as the second employee, one who is politically neutral. and the court has said in cases like elrod and branty, the decision to remain neutral, i see this candidate, i see that candidate, i'm going to not choose between them because for any individual reason, that that's protected, that's a political choice. in your precise hypothetical, both of those employees would have a claim. this case is different and crically different. the other side has quite consciously throughout the case made only two arguments, the first is that he was a supporter of spagnola and given up on that, the second is he had no association whatsoever. he didn't have any more association than i did. he was politically oblivious. so justice ginsburg, if you were to ask me that question, which is what sense does it make? the sense that it makes is one is exercising a constitutional
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right and one doesn't -- >> so just to make sure i understand what you're saying, suppose there's somebody who comes in to office, and it's a democrat, and he says i want as many democrats as possible in my office, no matter what jobs they're doing. now, what you're saying is he can't demote or fire republicans. he can't remote, demote or fire people who have other political views, neither democrat or republican, but what he can do is he can get rid of anybody who's just politically apathetic, is that your view? >> if that was actually the policy, then technically the answer to your question is, yes, under the first amendment. and i'd like to explain why. i know it sounds anomalous. the reason is that those people -- there is nothing in the first amendment that says that the government can't encourage people to be politically active. and that is entirely the point of elrod -- >> so are you encouraging the person to be politically active and then fire him or her because
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they're politically active the wrong way? >> no, sir. >> suppose the employee says, you know, i don't like the evening news. i like science fiction. i don't know if i'm republican or democrat, i don't care. he cannot be fired? what is his right? >> my point, justice kennedy s that he may have a state law right. he does have a collective bargaining right, but he doesn't have a first amendment right because he's not engaging in first amendment protected activity. >> see, i -- >> excuse me. >> sorry. >> the government has a right to compel him to declare one way or the other? >> justice kennedy, that brings us back to your question. and that is does he have a right not to have an inquiry into his political views? and that is of course not a right that's been recognized in any other political association context. when court discussed it in o'hare did it in a specific and important way. it looked at cases like elrod and branty, which are general policies. what the court has said there when it's a sweeping policy it's
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not necessary to inquire into individual political beliefs. and what those cases ought to be understood as is applications of first amendment overbreadth doctrine. it is common place in first amendment law that if you have a general rule and the general rule will be unconstitutional as applied to some people and the other people involved weren't asserting first amendment rights, the policy can be facially unconstitutional. and we don't inquire into the individual standing of the plaintiff. and that's what happens in elrod and bran ty. it's not necessary to inquire into the each individual employee. it is an entirely different -- >> see, i had always thought that the idea behind those cases is a different one. that the idea has to do with why the government acted. and once we say that the government acted for an impermissible purpose, which is to let's say in my hypothetical, get as many democrats as possible into the government, once we say that's an impermissible purpose, it matters not at all whether the person is a republican, an
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independent or somebody who's never thought about politics in his life because the government is acting in a way that's wrongful irrespective of that. >> we just disagree. it's called an individual right, not a government wrong. the individual has to be engaging in whether it's expression or -- i actually think it's not, justice kagan, in cases like watetwatters, an employee can't bring a case i didn't actually engage in speech but my employer thought i did. there is no first amendment right not to have this individual inquiry. and justice kennedy, rember that our position in particular -- >> so does that mean that the government can compel speech of a person if the person really just doesn't care one way or the other? >> no, it's a very important distinction. so let me give a hypothetical that ought to be hard for us, and that is heffernan is asked by the chief of police, you know, do you support the mayor? he's cometely agnostic and refuses to support the mayor and he's transferred.
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the decision not to support to be subjected to your hypothetic hypothetical, is a political choice. this case was framed by the plaintiff in a very specific way on purpose. and that is he disclaimed any such influence, any such pressure, any such choice that he was having to make. now, the important piece on this question of inquiry is that our position only applies to a party that doesn't claim anything other than being politically apathetic. so, justice kennedy, there is no inquiry. justice kagan is quite right if you have an independent, democrat, republican, the first amendment doesn't care. but if the plaintiff is going to pursue a claim that says i'm not engaged in association or speech, there's nothing to i inquire -- >> mr. goldstein, let's take a title 7 case. and the employer fires a woman because he thinks she's pregnant. she brings a sex discrimination case and alleges, well, i wasn't pregnant, i just was gaining
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weight. so she has no sex discrimination claim then because she wasn't pregnant? >> justice ginsburg, the courts are divided. the position of the eefc is that she would have a claim. i just think it's a good point for us though congress can write laws that recognize such regarded as claims -- >> those statutes focus on the employer. the employer cannot discriminate on the basis of sex. and that employer was doing that. the first amendment does not focus on the government. it focuses on the citizen. the citizen has a right to free speech and free association. that's the difference between the two cases. >> it will not surprise you that i agree, justice scalia. justice kagan, if we can take this outside the public employment context, and the reason i want to do that is we ought to be able to agree that the first amendment rights aren't greater association rights. the court pointed out there's a greater federalism interest in managing the public employment work force and also that this is an unconstitutional conditions
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case. but just imagine the following simple -- you know, hypotheticals that relate just to this case. imagine that the chief of police with the same motivation went up to heffernan as he went to pick up the sign, grabbed the sign and tore it up, or imagine that heffernan was trying to stop from entering a parade in favor of spagnola but what he was actually trying to do was just cross the street, or he went to the building where it is that spagnola had headquarters and chief of police stopped him from going in but he was actually going to his lawyer's office. those are all the exact same motivation. i don't think there's any way the court would recognize such a claim. it's a very sympathetic claim. i get the fact we are very concerned that public employees not be transferred or demoted, but we have other laws and other regimes that fill that gap. >> what is the other law here? what relief does he have? >> he has two forms of relief. the first is the collective bargaining agreement. i will tell you that it is not in the record, but it is judicially noticeable. it is a public document
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available on the government websites of the state of new jersey. and it is exactly what you would expect. in fact, it's a little broader. it says if you have an employment action that -- inequitable, it is grievable. the second is the attempt provision and justice scalia was right broader rights under new jersey law, this just makes sense -- >> do you agree that the petitioner is entitled to relief under that provision of the collective bargaining agreement? >> if his allegations of the facts are correct, yes. >> in your hypothetical about stopping the person from crossing the street, or they think entering the parade, the individual is -- has no right to insist that the government doesn't make a first amendment judgment about his activities? >> that's correct. justice kennedy -- >> in other words, the individual and citizen of the
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united states have no right, have no injury, have no interest in making sure the government doesn't evaluate everything they do from a political standpoint -- >> i think they have an interest, justice kennedy. i'm not saying that. we are concerned that people be able to have conscience, that they be able to make their own personal private judgments. but what we're talking about here in the context in which there's a real concern that i would like to talk about about whether it will interfere with the management of local government that it's an affirmative constitutional right. it's a violation of the first amendment. now, the reason you ought to be concerned, justice kennedy, is there's another side of the coin. take it from the perspective of the supervisor. if this right is recognized, which is to say the plaintiff need not engaged in any association, then the supervisor's expression of political views may well be chilled because he has to worry that any employee can say, look, i was regarded as politically active. if i could just give you this case again, and that is take the sign out of it.
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the plaintiff says he was well known as a spagnola friend and supporter. okay. imagine that that's discussed in the chief of police's office. but the chief of police thinks that heffernan really should be transferred, okay. the chief if the petitioner is right here really has to worry because if it's discussed, then there's every reason that heffernan can just bring a lawsuit saying, look, i wasn't actually involved in the campaign but you did it because he was my friend. and that is a very significant consequence for the individual rights. now, if we didn't have other protections that get to the concern about conscience, i could see the case being stronger. >> well, we know that you can't -- let's assume in this particular that you can't be fired because you're a republican or democrat. and that's what they do. but the person did not engage in that activity. he still is in the position of the government ascribing to him a political belief that he does not have.
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>> justice kennedy, that's right. the government thinks a lot of things about me. okay. some of them are not very nice, i imagine. and some are about my politics and that sort of thing. but there is not a constitutional right to have the government not think something about you. just remember as well -- >> here they thought and acted. >> okay, justice kennedy -- >> it's not just something. the government is taking action against a person because the government thinks that that person is exercising first amendment rights. and i thought unlike justice scalia that the thrust of the first amendment is operating on government. it says government thou shalt not act on the basis of someone's expression, speech or belief. >> well, essentially all of the rights, individual rights in the constitution other than the anti-slavery provision require state action. they all talk about what the government can't do. but what the government -- >> so here the government acted, no question they demoted the
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person. this was a detective. and they put him back on the beat. so the government acted. why did they act? because they thought that this person was engaging in political activity. >> well, justice ginsburg, let me just say i don't think it's contested after the petitioner's reply brief. you described this in first amendment terms. that if this was a speech case, which it used to be rather than an association case, he would lose. it is well settled in this court's precedence that the threshold inquiry under pickering is did the individual engage in the constitutionally protected activity. this actually is at issue, i should say, in the court's other associational case, this sitting, where there is a significant issue of is there a different rule that applies.
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standard case where the first thing that has to happen is the individual has to assert at least they engaged in the constitutionally protected activity. if you have an elrod and branty type case, which is what's discussed in that part of o'hare, it's an entirely different kettle of fish because there you do have a general policy. you could see people being chilled. you could see the government taking a broad view of its employees. >> thank you so much for how that works. it just seems to break down very easily if you can't have a broad rule that says that you can fire everybody but democrats. but you're saying that you are going to allow somebody to come in and fire people one at a time. >> justice kagan, that's of course not what i'm saying. what i'm saying is that under first amendment overbreadth doctrine, when you have a general policy, and this is what we think happened in elrod and branty, the fact you do not inquire into the individual person's political views beuse the policy is facially unconstitutional. but it has never been the case in any context. and the other side has had every opportunity in the world.
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we cannot find any first amendment case that says, you know what, you don't have to engage in constitutionally protected activity so long as the government thinks you did. and it's really a problem if that's the rule because it is the threshold thing that stops plaintiffs with meritless cases from getting out of the box. in all of these cases if the plaintiff no longer has to say i engage -- >> if you were saying, and i think you said this straight out, you're saying i can come into an office, i'm a democrat, i can identify every person without a well-known political view, every couch potato out there. just fire one after another after another after another. replace them all with democrats. change the entire character of the office. do for a reason that i prefer one political view to any other and that that will not be a violation of the first amendment. >> two things. first, i think it is practically impossible because you would have to somehow magically pluck out the people who are
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politically apathetic from those that are politically neutral. and i just don't think you can do it. but the second is, that's right. the constitution doesn't fix everything. >> you want this court to hold that the government of the united states has a right to ascribe to a citizen views that he or she does not hold? >> justice kennedy, i think that that is not a first amendment violation. i don't think the other side thinks it's a first amendment violation. remember there's the materiality requirement? >> see, i had always thought that the first amendment running through all our cases is an extremely strong strand that part of the reason we have these protections is because we worry that government is doing things for impermissible reasons. that the government wants to create a world of speech in which everybody agrees with it and nobody opposes it. and that that's a fundamental tenant of what the first amendment and all our cases are about. and you're saying, oh, no, the government's motive doesn't really matter as long as you can't point to somebody who is holding up a sign. >> justice kagan, i think you
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are right. it is an important thread of this court's decisions. and the court has said it is a necessary but not sufficient condition. waters makes very clear, which is a first amendment public employee case that the individual has to have engaged in the constitutionally protected activity. every one of the garsetti says the same thing -- >> can i just approach the same thing from a different perspective. suppose can congress pass a law or a legislature pass a law that attempts to abridge the freedom of speech? is that a violation of the first amendment? it's an attempt. >> what would the attempt -- >> well, give examples. pass a law no one can aspouz in a public place the political philosophy of rur tal tan yanis.
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i assume they'll pass a law. they pass it. by the way, the six people who hold that philosophy, all leave on a boat before the effective date. but -- or, what's more likely, they bring a declaratory judgment action an the law never takes effect. and therefore it had no impact. and that happens every day of the week. i'm just wondering if such a law, which is an attempt write on the books as blatant as you want whether that violates the first amendment? that's a serious question. i'm not taking a point of view. i want to know what you think. >> justice breyer, the reason -- >> i want to know. yes or no, does it add up to a clear attempt to violate the first amendment, in a statute as general application, does it violate the first amendment? does it abridge the freedom of speech? >> if it's only going to be an attempt and it's not going to succeed, no.
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the statute you describe is unconstitutional. >> it is unconstitutional. >> that's right. there are all kinds -- >> it will have a lot of bad effects. all kinds of chilli ining effec all over the place. >> if the statute doesn't -- >> no, no, by chance it happens not to succeed. >> justice breyer -- >> it's my hypothetical. >> i know. i'm just trying to keep up with it. in the one that you just described, justice breyer, if it is the case that the law's going to go into effect, we do allow  overbreadth grounds -- >> of course. i'm just asking you if in fact i think it will succeed, they want it to succeed, that's why they passed it, and through a fluke it fails. does the fact that it fails mean that it doesn't violate, it doesn't -- does it or does it not violate the first amendment? >> it doesn't. >> it does not. >> here would be an example. >> if it fails --
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>> if i can just finish, justice breyer. if congress at the same time passed a law that said no federal funds shall be used to implement the ban on talking about the political vie of rueratania, we tried but the money was taken away from us, it's not unconstitutional. >> or you could say the law is passed by congress but vetoed by the president. is there a violation of constitution? >> there would not be. but in my hypothetical or in justice breyer's where it actually goes into effect -- >> we're off on a tangent because there's no injury in this situation when the law doesn't go into effect. but coming back to what justice breyer i believe is attempting to say. [ laughter ] i don't know, mr. goldstein, that i understand either. and i think justice kagan asked you this, why does it matter? and we don't care whether someone is a republican or not
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in elrod and those cases, and you say it's only because it's a policy. the intent of the government is to say i'm not going to promote anybody who is not a democrat or not a republican. >> more than a policy. it will actually have adverse consequences -- >> well, someone they've gone along and not promoted people. >> no. >> all right. so you have to have someone come in and say i'm not a democrat? i'm not a republican? you need someone to tell you what they are? >> no. common sense does not leave the courthouse. and that is if i have a policy that says i will not hire democrats, i think a court would understand that there are going to be democrats who would apply for jobs. there doesn't need to be an inquiry. >> so then why isn't it simple to say i'm not hiring you, or i'm demoting you because you
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politically associated? and doesn't that chill the person from even walking by a campaign? doesn't it chill others who do want to associate marginally? i'm assuming that there's no policy in place. nothing to prevent this otherwise like the hatch act. >> i think it's a really important point on the question of chilling. because elrod and branty and the rules that -- and o'hare, which is a one-off case, do say that you can't do this for political purposes if the person is actually exercising a constitutional right. so that we all agree that if the plaintiff here was a supporter of spagnola, or even if the mayor had decided to remain politically neutral, this is a bizarre case that he comes to the assumption that he's completely politically apathetic. >> it is bizarre. do you really believe, mr. goldstein, that the constitution does not solve all problems?
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you made a statement to that effect. you really believe that? >> no. >> it doesn't solve every problem. >> no, i do think there's a concern that comes into play. i do not to demean the concern about the government having a sense of what individuals political views are. but i'm saying that that happens, your honors, in all kinds of cases. whether it's redistricting, campaign finance, there's lots that we do to ascribe political views to people in this country. and adopting that doctrine is going to have pretty widespread consequences when it's not necessary. i do think that it should be common ground that there are multiple layers of protections for these employees. the basic rule. and, justice kennedy, remember under the basic rule the plaintiff has always come in and said i'm a mocrat. right, the elrod branty rule involved one-off cases. the opinion in o'hare describes the political views of the tow truck company there. and it has never been regarded as a first amendment problem when you don't actually exercise any first amendment rights.
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>> that is a first amendment problem for the reason that lots of other people will have their speech chilled. and normally in the law there is a doctrine where the person who does the bad thing makes a mistake, he's held any way. that's true of transferred intent. you shoot a but you meant to shoot b. it's true of attempts generally. >> it's not true of the constitution. >> why not? that is to say i would think that a statute that has a chilling effect on the speech of millions of people that is directly aimed at a, b and c, if because of some fluke a, b and c are not themselves injured, nonetheless everybody else is and it would still violate the first amendment, that i think is what you have here which is why i raise my point. >> great. justice breyer, if you would just contrast in your own mind the statute that affects millions of people versus the beat cop who talks to one person in terms of its chilling effect.
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because first amendment overbreadth doctrine was born because of your hypothetical. the concern that a broad policy or statute will have widespread effects, that is not anything like this. >> do you know of any case in which we have relied on chilling effect where what was at issue was a one-off like this one? as opposed to a general policy which had a chilling effect? i don't know of any case. >> to the contrary. i can tell you that in both waters and garseti. the court said, look, we recognize the rule being proposed to us. in waters it was the idea the employer's views wouldn't matter. it would just be whether the speech is protected. in garsetti, it was the question of whether it was the public employer speech. and the public employee argument in both those cases is, look, these rules are going to chill speech because there are a number of uncertain boundaries. we need to have wide ranging expression. if i have to bring my case there
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will be inquiries into my speech views and the court said, look, we have to balance things here. there is a real concern rooted in a history of the united states involving political patronage. the court has never tried to extinguish politics from local government. and if you try to do that in new jersey, we are going to be here a lot. >> and the question in this case seems to me to be highly artificial. it's like a law school hypothetical. >> i agree. >> how often will it be the case that an employee will be unable to allege any expression or any association that is protected by the first amendment? it seems to me quite rare. and it may be that this case comes to us the way it does because the plaintiff was dealing with two things. one was the first amendment. and the other, i mean, one was the issue -- the question of his motivation. and the other was this alleged policy, prohibiting any kind of
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political activity. even in the person who's just apathetic. is there not a first amendment right to be say i don't like politics, i don't want anything to do with politics, i'm not going to register, i'm not going to vote? >> justice alito, the third circuit has a rule discussed in the brief opposition adopted in a case that says you do have the right to be politically apathetic. the reason the case is so bizarre is that the other side for its own reasons decided not to assert that right. now, i will say that it does nonetheless matter because there are going to be other kinds of cases where you have a public employee that just is not asserting any rights at all and is not involved say in environmentalism or gun rights or whatever. and the public employer if it's thought just to have perceived the employee as having been involved in some association then is subject to a claim. >> sir, you have to -- you have to show some facts to draw that inference. you just can't say i'm involved
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in this and the employer fired me because of that. you have to show some connection between the firing and the political belief. >> i would just take you back to my hypothetical of getting rid of the sign. his support of spagnola is discussed in the chief's office, right? and then he has to be reassigned. and the chief has to really worry that he's going to be sued. my point is this, the set of cases you have to be concerned with there have been no other cases we've been able to identify like this one. it is very small. but the downside risk is significant. >> if somebody had come in to me before today's argument and just said, does the first amendment prevent the government from punishing a person because that person does not share the government's views? i would have said, well, yes, of course the first amendment protects that. that's the whole point of the first amendment. and now you're telling me, no, the first amendment does not prevent the government from punishing a person because that person doesn't share the government's views unless that
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person is actively opposed to the government's views. but if that person just really could not care less, which a lot of people this this country could not care less. they don't vote. they don't pay attention. they wouldn't know who is running. but the government can punish that person because that person doesn't share the government's views. and i would have said that is one strange doctrine. >> it may be that i have not persuaded you in this case. i will say, justice kagan, you ask can the government do it? the government cannot because there are lots of other protections. and remember, if the person is politically neutral, it is the case that the right of political association is the right of political association. if you aren't engaging it, you aren't actively pursuing the right in any way. even if you aren't active about it. >> thank you, counsel. mr. frost, you have a minute left. >> thank you, mr. chief justice. couple points i want to make with respect to declaring one as
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a neutral. if heffernan was engage d in political activity, i support spagnola, of course he would be protected by the first amendment. what i'm hearing is if he were neutral he would be protected. i see little difference between being a neutral and being agnostic in the sense that i'm not taking a position -- >> i'm so totally confused. i know the way it was presented to us, but i thought he testified that he had made a choice not to get involved in the campaign but that spagnola was his friend and he supported him. so he wasn't neutral. he just wasn't engaging in associational conduct by choice. that's what i thought. >> that's correct, justice sotomayor. and the point that i was trying to make was the fact that in this case he was not going to be exercising his right to vote or
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campaign for him but clearly he engaged in what we would consider core first amendment activity by picking up that sign. the mistake that the employer made was actually one that they perceived him as actually campaigning on behalf of spagnola. and that should make no difference for the simple reason that with respect to that activity it's because the court sees that the government is acting for an impermissible purpose. >> thank you, counsel. the case is submitted. road to the white house coverage later today on the c-span networks. former florida governor jeb bush is in carroll, iowa, to meet with voters. we'll have that event live today at 1:45 p.m. eastern on c-span. the town is located northwest of des moines. and ben carson will meet with voters in iowa city at the university of iowa. he'll be joined by senator chuck
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grassley. and that's scheduled to start live 3:00 p.m. eastern time on c-span2. the weekend prior to the caucuses there will be a frenzy of activity across iowa. i mean, there are so many candidates on the republican side. there are three viable candidates on the democratic side. and they will have each of them three, four, five, six events a day. what we're going to be looking for are those events that really give you a sense of what it's like to campaign for the caucuses. because keep in mind what's key is organization. you need to make sure that those people who support you get to the caucuses. so it's going to be interesting to see how the candidates are trying to close the deal, sell their message and convince those people who might still be on the fence to go for candidate a or candidate b. so what you'll see is essentially wall-to-wall coverage on c-span as these candidates make their final pitches. >> c-span this weekend. live coverage of the presidential candidates in iowa.
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the director of the national institute on drug abuse says the overprescribing of painkillers must be addressed and is tied to heroin addiction. dr. nora vocal testified before experts and the judiciary committee. >> i'll make opening statement leahy and then we'll go to the order that we have established. as you see people sitting at the table there. i'll introduce senators and senator leahy will introduce the governor. america is experience an historic epidemic of drug overdroes deaths. over 47,000 died from overdoses in 2014. that's an all-time high. to put this in perspective, it's more deaths that resulted from either car crashes or gun violence.
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addiction to opioids primarily prescription painkillers, and heroin, is driving this epidemic. it is destroying lives. families. and the fabric of entire communities. it is something i'm hearing about in iowa. of course other parts of the country have been hit even harder. at today's hearing the committee will learn more about this terrible epidemic, what's being done to address it and how congress can help. the committee looks forward to learning more about the comprehensive addiction and recovery act, which is the result of the leaderships of senators whitehouse, portman, cloeb char, ayotte on this important issue. over the last 20 years or so doctors have increasingly prescribed opioids to help their patients manage pain.
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for many these medicines have been the answer to their prayers. but for others they have led to a nightmare. a nightmare of addiction. the new england journal of medicine estimated over 10 persons reported abusing prescription opioids at some point 2014. the emergency room visits involving the misuse of the prescription opioid increased between 2004 and 2011. treatment admissions linked to them more than quadrupled between 2002, ten years later, 2012. to you -- the use of heroin has also spiked sharply. the national survey on drug use and health reports over 900,000 americans used heroin in 2014,
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nearly a 35% increase from the previous year. heroin deaths more than tripled between 2010 and '14. in 2007 only 8% of state and local law enforcement officials across the country identified heroin as the greatest drug threat. now, this year -- or last year, that number rose to 38% more than any other drug. according to numerous studies, prescription opioids, addiction is a strong risk factor for heroin addiction. in some cases those addicted to painkillers turned to heroin to get a similar high because recently it's become cheaper and more easily available. now, very important question. why has cheap heroin begun
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flooding into our communities? well, mexican cartels are expanding into new territory because the administration hasn't secured the border. indeed heroin seizures at the border have more than doubled since 2010. the senate caucus on international narcotics control joined by our colleague senator ayotte sought accountability for this alarming development at a hearing in november. so this is a complex crisis requiring a multifaceted solution. the first and most important part must be prevention to head off addiction before it can even begin. prevention includes educating the public about the dangers of these substances including through the important work of anti-drug coalitions. it also includes educating doctors, taking a hard look at perverse incentives that may
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lead to overprescribing. for example, a few weeks ago senator feinstein, ayotte and i wrote to hhs to seek a progress report on a federal review exploring whether patient satisfaction surveys linked to higher medicare payments actually encouraged doctors to prescribe opioids. many people who abuse prescription drugs get them from friends or relatives, so prevention always -- also involves support for initiatives that allow patients to safely dispose of older, medications. so that brings me back to something i was involved in to help start these takeback programs by working with senato senators the responsible drug disposal act.
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i was pleased when d.e.a. acting administrator rosenberg voiced his support for them very recently. at the same time it's concerning that this administration is muddling prevention efforts by sending mixed signals to young people about the danger of addiction to marijuana. the president has even accused smoking marijuana as just another bad habit. and the department of justice continues to decline enforcing our federal drug laws in this area. but young people don't need increasing access to another potential pathway to addiction. according to cdc report a person who is addicted to marijuana is three times more likely to be addicted to heroin. another part of the solution needs to include better treatment options for those who become addicted. the use of medication assisted
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treatment appears to show promise. so along that line overdose deaths may be reduced by the more widespread use of a drug proven highly effective in reversing overdoses. and finally, law enforcement will play a very critical role. we can't arrest our way out of this epidemic, but we can continue to crack down on unlawful prescribing practices, enforce our border with mexico and target the violent cartels that are trafficking heroin in this country. so i get back to something else a member of this committee and i have been involved in. senator feinstein and i introduced the transnational drug trafficking act 2015. our bill would make it easier for the department of justice to prosecute cartels who harm our
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communities from abroad by trafficking heroin, other drugs and precursor chemicals. for ultimate delivery here in the united states. in october our bill passed the senate for the third straight congress by unanimous consent but hasn't found success in the house. so it's critical that the representatives finally pass this legislation which will help protect our communities from transnational drug trafficking threats. so i'm finished. i welcome our guests. and i'll introduce them. and now turn to senator leahy. >> well, thank you very much, mr. chairman. i think you look around this committee, republicans and democrats from representing all parts of the country, we know that in our communities whether they're urban or local, doesn't
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matter what their size, they're grappling with the tragic effects of the epidemic of heroin and prescription opioid abuse. we've all seen the statistics. i'll tell you one thing about the dramatic rise in overdose deaths particularly among young people. but go behind the numbers as i have, governor shumlin in our state has, eric miller, our u.s. attorney has, and behind the numbers you see the human impact of this epidemic. families trying to find treatment for a loved one hooked on painkillers. children neglected or left behind by an addicted parent. victims of crime fueled by addiction. law enforcement community officials overwhelmed by the flood of opioids and cheap heroin. my wife is a retired registered nurse. she and i have sat around some of the kitchen tables in
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vermont. and our some okay are very affluent areas and some are very poor areas. but the stories we have heard from families and parents, and we usually go there just ourselves, no press, nobody else, just want to talk to these people. we've had a couple times we've driven away we were both in tears what we've heard. these are human stories. go way beyond the statistics. so it's not a question of whether there is an epidemic. the question is what do we do about it. like many other states we've not been immune to this in vermont. but in probably what we do in vermont, we rally together to tackle the problem head-on through community based and comprehensive strategies. that makes me proud to be a vermonter. we heard testimony about a
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number of these innovative approaches during a series of field hearings. i convened during the past several years in vermont. in one city in rutland they went to the mayor, a strong republican i might say, and they said do we want to talk about this in our city. said we darn well want to talk about it. and we had to keep changing the venue because more and more people wanted to come. we had city officials, their project vision, city officials, law enforcement, residents. and we heard from all of them knowing that this is not just law enforcement, it's not just a medical profession. we had the faith community, parents, educators. they're all in it together. the boys and girls clubs throughout vermont are working with schools and public health officials to help children swept up by this. in all of my conversations though with vermonters from law enforcement down through one thing is clear, we cannot arrest
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or jail our way out of this problem. we've lost the war on drugs because we relied primarily on a necessarily harsh sentencing laws. we can't repeat these mistakes of the past. we've also got to start working on the demand. we can close everything -- let's assume we can close everything coming from mexico. if have demand in this country, it will come from somewhere else. so long as we have people who spend the money who want to buy the opioids, who want to buy the heroin, it will come here. i don't care which border we close. it will come here. we've got to stop the demand. we have to identify and support effective prevention treatment recovery programs. and we can't just pay lip service to our communities. after the field hearing i convened in rutland i advocated for a new federal grant program
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for expanded treatment options for heroin and opioid abuse. i work to get more federal funding for law enforcement to go after drug traffickers. in vermont we've seen a 65% increase in the number of vermonters getting treatment for their addiction in the last couple years. and, governor, i thank you for that. it's great progress. but we know on any given day there are hundreds more find themselves on waiting lists. the patients in rural corners of my state travel hours just to get their medication. so seeing senator shaheen, i co-sponsored her bill to fund additional public outreach and treatment in recovery and law enforcement efforts. proud to co-sponsor the comprehensive addiction and recovery act. hope the committee will report that bill soon. we can talk about it. we can have bills. we can have resolutions. let's spend the money. let's spend the money for things outside our country. let's spend the things -- spend
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money for things in our country. this is a great danger and we should spend money on it. so i will close with close by t governor shumlin. the governor gave in his state of the state address in the past, instead of saying everything's going great, we've got all this, as most governors do, he talked about this problem. that was his whole issue. boy, the reaction around our state and around the country saying it is about time, it is about time somebody speaks up. so senator grassley, i thank you for convening this hearing but we've got to find comprehensive and enduring solutions. federal government will do its part to provide resources and support that's necessary. that's important. but we have to act. we're not going to rest our way
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out of this. everybody in law enforcement knows that. we're not going to do it by simply saying let's course a source from one country because it will come from another country. we've got to attack and work and do all the comprehensive programs in the faith community, the educators, law enforcement, parents, medical facilities, to stop the demand. until you stop the demand. we'll always have the problem. thank you. >> why don't you continue your introduction of the governor, if there's anything else you want to say at this point. >> well, thank you. go ahead. >> obviously when you're introducing colleagues like i'm doing, there's -- you know an lot about them that ought to be said. but you have to kind of keep -- >> can't do that. >> but i can say all of them are extremely dedicated to fighting the opioid epidemic sweeping
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their communities, and i'm grateful that they're all interested in this and that they have been button-holding me for a long time to move along with this hearing. and i think from initial discussions with members of this college, we bofeel both from a cost and substance standpoint we can move ahead. i hope that's the outcome. first witness, senator ayotte, new hampshire. co-author and original co-sponsor of this bill, s524, the comprehensive addiction recovery act. she is a former prosecutor and attorney general, was one of the leading voices in congress seeking solutions to opioid epideme epidem epidemic. our second witness, senator shaheen, also from new hampshire. she is also co-sponsor of the
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measure and have been highly active. new hampshire is fortunate to have two senators working across the aisle on this very important crisis issue. next, senator rob portman from ohio, co-author and lead republican sponsor of cara. he's worked tirelessly bringing awareness to this epidemic drought the state, involved in the drug-free community act and also probably 20 years ago came to my state to help me with a non-profit organization that i started in my state as well so our relationship on this issue goes back a long, long time. as a small business owner, public servant, father of two, two wonderful young women.
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he's a committeed entrepreneur, a long-time co-director, along with his brother with a national geographic student expeditions. your brother told me he's counting the days to get you back there in the company. it is a company that sends students on educational programs and student project across the globe. partnering in several real estate companies that provide housing and commercial space in southeast vermont. i've known him forever, seems his career spans 30 years ago when at the age of 24 he was elected to serve on the town select board. in 1990, he was appointed to fill an empty seat in the vermont house of representatives. he served there three years. he then served for eight years in the vermont senate where he was elected by his colleagues, republicans and democrats alike, to lead the senate as president pro tem. he's the 81st governor of
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vermont and and is a very close personal friend. >> thank you all very much and we'll do it in the order that i introduce you so senator ayotte, senator shaheen, senator portman, then the governor. proceed, please. >> thank you, chairman grassley, ranking member leahy, members of this committee. i am so pleased that you're having this hearing today because this is the most urgent public health and safety crisis facing my home state of new hampshire. having served as the attorney general of our state, i can assure you, i have never seen anything like this in terms of the epidemic that we are facing. so the timing of this hearing could not be more important. i'm very honored to be here with my colleagues, senator shaheen. in the fall we held a hearing, a field hearing, of the homeland security committee and heard from people in new hampshire, but we also heard from the
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director of the office of national drug policy who's been a very strong partner with new hampshire. so i appreciate the work that senator shaheen and i have done together on this issue for our state. i'm very honored to be here with governor shumlin who's had such a keen focus on this issue. finally, i want to thank my colleague senator portman who's been a leader on the comprehensive addiction and recovery act. he started his own anti-drug coalition in ohio. he's also led the effort when he was in the house of representatives to pass the drug-free communities act which spawned coalitions across this country. now working with senators klobuchar and whitehouse, i was proud to introduce the comprehensive addiction and recovery act. i want to thank the members of this committee who are sponsoring this act.
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today you will hear in the third panel from the police chief, nick willard, of our largest city, manchester, new hampshire. he is going to talk to you about the epidemic facing our state, how we can address this together, both law enforcement, working with those in prevention, treatment and recovery, and i had the privilege of doing a ride-along with the manchester police department. and i also did one with the manchester fire department. i was there an hour and a half. we went to two heroin overdoses within an hour and a half. and i can assure you, this is hitting every family in some way in new hampshire. i watched our first responders bring people back to life with narcan. but for them being there and having this life saving drug, they would have died. it just really struck me how
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devastating this is. because one of the cases i went to, there was a baby in the crib in a corner. so when we think about there, this is not just the impact of those who are struggling with addiction, it is the impact on all of our quality of lives and of course on the future for our children. in new hampshire, in 2014, we had 320 drug overdose deaths. that was a 60% increase from the year before. this year our chief medical examiner tells us that 385 -- 148 of those deaths are also attributed to a devastating drug called fentanyl which dea tells us is 50 times more powerful than heroin. and that is an issue i believe needs to be addressed by this committee as well. solving this crisis requires a whoelistic approach. comprehensive addiction and recovery act that so many
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members and i really appreciate the leadership on this committee on this act -- is critical, i believe. we brought together over 1 20 stakeholder groups around the country to put this legislation together. those who were on the front line in every aspect. it has the endorsement of the national district attorneys association, the major county sheriff's association, the community anti-drug coalitions of america, and the national associations of attorneys general. my attorney general from new hampshire has endorsed it, the iowa attorney general has endorsed it, the vermont attorney general has endorsed it and many others of your attorneys general have said please pass this legislation. it focuses on a holistic approach. expanding opioid prevention efforts. we have to get into the schools and get prevention focused on
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opioids, prescription drugs and also heroin. expands the availability of narcan to first responders and law enforcement. support to additional resources to identify and treat incarcerated individuals so that we can end the resolving door that we see in our prisons. expands drug take-back efforts to promote the safe disposal of unused or unwanted prescriptions. strengthens prescription monitoring drug programs. and launches prescription opioid and heroin treatment intervention programs. we can administer narcan and our first responders are doingen a amazing job of bringing people back to life. but if we don't get the support and treatment for those who are strugglinging with addiction and deal with the underlying issues, we are not going to solve this problem. as the chairman -- and you will hear from chief willard today -- we cannot arrest our way out of this problem. this is not just about statistics. this is about real people dying, real people like courtney griffin, from new hampshire, who was 20 years old and had such a
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promising life before her. real people like the grandmother who told me the other day, as she waited on me in the store, i lost my granddaughter. we can make a difference in the senate and in this committee by passing the comprehensive addiction and recovery act, by working together to not only support our first responders, but to make sure that we're focusing on prevention. make sure that those twho are struggling addiction, that we get them support and treatment for recovery. most of all, we can turn this around. because i've also heard the redeeming stories, people like eric spauford who was addicted to heroin and now has established treatment facilities in new hampshire and is turning this around. but we need to act immediately. this is a crisis. i'm so glad that you're holding this hearing today. i thank all of my colleagues who are working on this issue, and i thank this committee for its leadership and i look forward to working with you.
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thank you. >> thank you, senator ayotte. >> thank you, chairman grassley. ranking member leahy and members of this committee for giving me the opportunity to testify this morning. i am a co-sponsor of the comprehensive addiction and recovery act and i appreciate the leadership of my colleague, senator ayotte and all of you on the committee who are working on this legislation. i'm actually here to testify, however, not on that bill, but on two bills that i've introduced. the opioid and heroin epidemic emergency supplemental appropriations act. two allocate $600 million in emergency funding to address this national crisis. the second bill is the combat hair wane epidemic and backlog act which would authorize a grant program to help reduce the chronic backlog of heroin and fentanyl cases at state police
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crime labs. and mr. chairman, you and senator leahy and my clear, senator ayotte, talked eloque eloquently about the statistics that affect this epidemic. but the fact is, i believe what we have now is a pandemic. it is affecting young and old, it is affecting urban and rural, rich and poor, white and minorities, and it is spreading to every state in this country, including i alaska and hawaii. in new hampshire we're losing more than a person a day to drug overdoses. last year, three times as many people lost to drug overdoses as traffic accidents. and we just had a study come out on mortality rates in this country that show that mortality rates among middle aged white americans are actually increasing for the first time in decades, rather than decreasing. and that was attributed primarily to the rising substance abuse disorders.
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so as senator leahy said, those statistics don't adequately describe the devastation to families who have lost loved ones and who are still struggling with trying to get loved ones into treatment. but despite all these statistics, despite the stories that senator ayotte and i have heard in new hampshire, and that all of you have heard in your home states, public health and law enforcement agencies at all levels lack the resources to mount an effective response to the heroin and opioid epidemic. and nationwide, in 2013, nearly 9 out of 10 people who needed drug treatment did not receive it. this is tragic, and it is unacceptable. and we need to mobilize a national response. my legislation proposes $600 milli million. specifically it provides an additional $200 million under
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the edward burr momential justice assistant grand fund to aid state and local effort in prosecutions been law enforcement and court programs, drug enforcement, treatment programs, as well as education and prevention. lest you think $600 million is too much, remember that last year congress passed $5.4 billion in emergency funding to combat the ebola outbreak. and we lost only one person in the united states to ebola. in 2009, congress passed nearly 2 billion in emergency funding just to fight a swine flu epidemic. so we need better coordination and better resources. i think you will hear from chief willard the challenges they have in new hampshire because they don't have resources they need. i also want to touch briefly on the combat heroin emdemmic and backlog act which is designed to help drug labs -- crime labs across this country as they
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analyze drugs. this bill is modeled on what we did in 2005 to combat methamphetamin methamphetamines. what we are seeing in new hampshire and across this country is that state police forensic laboratories have accumulated ed d a backlogs of n and fentanyl cases because they don't have resources to do the testing. in new hampshire, the state forensic lab receives about 750 testing requests each month, but it can only process 450. and the growing backlogs result from an increase in heroin cases and a dramatic surge in fentanyl cases. just to give you some idea of senator ayotte touched on this, but in new hampshire, according to our chief medical examiner, in 2013, we had 193 overdose deaths. 18 of those were fentanyl related. in 2014, we had 326 overdose
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deaths. 145 of those were fentanyl related. and in 2015, we had 385 deaths from overdoses, 253 were fentanyl related. we have got to act with a sense of urgency because delays in processing drug samples have disrupted every stage of the policing and judicial processes. we are no longer able to identify combination and designer drugs by sight. undercover law enforcement are forced to wait to verify samples before continuing investigations. and prosecutors and judges are less likely to offer plea deals without lab confirmation of a drug's authenticity. put simply, these backlogs are keeping us from putting dangerous criminals an drug traffickers back in jail and off the streets. so, mr. chairman, there's j
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obviously a lot ever work that we need to do to adr. es thdres pandem pandemic. it is going to take a multi-faceted approach, together, and you've got to act now before things get even worse. >> thank you, senator shaheen. senator portman. >> thank you for having the hearing today a letting us come before you to talk about a critical issue we face in every single one of our states. in practically every community in this community. that's this epidemic of heroin and opiate abuse. senator ayotte talked about the comprehensive addiction and recovery act, cara, a bipartisan bill that addresses this issue head-on in a comprehensive way, through prevention, through treatment, through recovery. it is one i've had the privilege to work on with my colleague and
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co-author sheldon whitehouse who's on this committee, along with senators ayotte and klobuchar. we've been working on this for a few years now. we've brought in experts from all around the country to give their best advice. this committee's done some good work already. i was very encouraged, mr. chairman, by your comments earlier an by the ranking member's comments about the importance of addressing this issue in a comprehensive way and about the importance in moving this legislation forward and again, i thank you for that. i think it is the appropriate federal response to this growing epidemic. i also want to thank those experts out in the field from every area, prevention, all the way through recovery, who have worked with us over the past years in putting this together and participated in about a half dozen forums we've had here in washington, d.c. where they've given us their input. we've all been back home, too, getting input. no matter where i go in my home state of ohio, i hear the same story. i hear it from mothers, i hear it from fathers, sisters,
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brothers, friends. i hear heartbreaking stories of how addiction is ruining lives. tearing apart families. devastating communities. this epidemic is striking very close to home. i know you're hearing that, too, as you go home. last year, 2,482 ohioans died from a drug overdose. that should demonstrate to all of us how difficult it is to break through this addiction, the bonds of addiction are so strong. recently i was in a hospital last week in cleveland, ohio looking at the amazing care they are giving to addicted babies. i had a chance to talk to some mothers who continue to use during their pregnancy. that's how strong these bonds of addiction are. thousands more, of course, are surviving these overdoses, but they are still struggling to hold a job, they're struggling to take care of their families. economists tell us that addiction now costs this country
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700 billi$700 billion every yea. that's lost productivity, more expensive health care, it is what's happening to our emergency rooms in all of our states. it is more crimes. temperatures the cost of incarceration, it is the cost of policing. that's a lot of money. but of course it doesn't tell the true cost in human lives. you all talked about that this morning. it is the cost in dreams that are never fulfilled. i think this hearing will be very effective in helping bring awareness to the severity of the problem. we've heard it already this morning. but i think it is just as important that we talk this morning about the reasons for hope, that there are alternatives out there, there are ways i to a i dto address t ways to combat this epidemic and lives can be saved. no one knows this better than senator grassley and senator leahy because they've been at this for a couple of decades. i worked with them back on prevention strategies that actually worked. and we had spawned more than
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2,000 community coalitions together with the drug-free communities act. but now we need to do more, focus more on not just prevention and education but dealing with treatment and recovery. i've seen some amazing people who lead programs in my sta that actually work. i visited with a lot of men and women who struggle with addiction and have the courage to seek treatment and get on the road to recovery. i've also been fortunate in you have to get to know a lot of ohioans who have taken their personal tragedies, channeled their grief and used their story to help others avoid addiction or break the stigma of addiction. you'll hear from one of those women here this morning. tanda, i first met, last fall. she came here for the rally on the mall against addiction and she told her story to me. her story is one that breaks your heart. her daughter, holly, was 21
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years old when she died of a heroin overdose. now to the outside world, holly didn't fit the stereotype of someone who was a heroin addict. she excelled in school. she had a lot of friends. she was selected for homecoming and prom court. she was building a life for herself. she was engaged to be married. and then on her 20th birthday, at a celebration, some friends of hers said, why don't you try this? and they gave her some heroin. she thought she would experiment with it. and she got into the grips of addiction. tanda did, as you'll hear later, i suppose, what any mom would do. she helped her daughter try to get into treatment. holly went to rehab. she actually gained a period of sobriety. but then the addiction took over. she overdosed. and she died.
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tanda, again, has taken that tragedy and used it in a constructive way to help others. her group is called holly's song of hope. she has chapters around ohio and around the country. it is in the hopes that other daughters will not follow that similar dangerous path. i commend her. there are so many others who have done the same thing i've met in the state of ohio. last week i visited marion, ohio and i met bethany who has struggled with heroin addiction. she struggled pass a teenager. she was a promising athlete. she was going to college. she had a scholarship. but she got sidetracked through her addiction. she was an expecting mom and she used. and she says that tearfully now. she was arrested. law enforcement tried to deal with her issue by not putting her in jail by finding alternatives. she finally figured out she had
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beat her opiate addiction because of her kids. and she did it. detox was hard, recovery even harder. but she went on to graduate from marion's treatment court and alternative sentencing program where they provide resources for mothers facing substance abuse. after five years of being sober, bethany now leads that specialized docket as the court coordinator to help other mothers in recovery. to my colleagues this morning, the story of bethany tells us why there is hope in the face of this addiction. you've seen it in your states. we've seen it around the country. people can break this grip of addiction and get into treatment and recovery. it is hard. they need our help. listening and learning from these families is what helped us inform our work on c.a.r.a., eve every step of the way.
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this legislation is xr comprehensive, and will help these communities with all these proven strategies. i am committed to passing this bill and getting it signed into law because i truly believe it will make a difference in the lives of the people i represent. i once again want to thank the nine members of this committee who have co-sponsored this legislation. i want to thank those who are willing to work on getting this reported out and on to the floor for a vote. and again, i'm encouraged at what i've heard this morning. i think c.a.r.a. is an investment. it is not inexpensive. but it is an investment at a time when communities are desperate for resources and expertise to best practices that come through this legislation. it is a small investment for the future. we will know success by the number of empty jail cells and the number of people who never have to struggle with addition in the first place, the moms and dads who can be reunited with their kids.
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the message today, there is something we can do to help. from those who struggle, you are not alone. we are with you. there is hope. and that hope can be furthered by this committee leading the way by reporting out this legislation. thank you, mr. chairman. >> thank you, senator portman. now governor schumlin? >> thank you, mr. chair. it is a real ln nor to be here to share some of vermontary story with you. i got to thank my great friend, senator leahy, for inviting me down and giving me this privilege. i'm glad to have my u.s. attorney here with me, eric miller. and maybe before i add to your colleague's extraordinary comments on this crisis, i just have to tell you this.
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i made the mistake this year of laying out my proposals and half-way through the speech in the state of the state i acknowledged two of my favorite people on this earth, senator leahy and his wonderful wife, marc marcel. they got the longest, biggest standing ovation of the speech. needless to say, the press wrote senator leahy and marcel get biggest standing ovation of the speech. that's all moderators heard about my state of the state. so i won't make that mistake again. listen, i was going to share with you many of the stories -- heartbreaking stories that you've just heard from your extraordinary colleagues from new hampshire and ohio, so i won't. vermont has the same heartbreaking stories. when i dedicated my state of the state address to this subject, needsless to say, it was a pretty lonely place for vermont to be. there was a long debate about whether vermont really had that big a problem, and should the governor really be spending this
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much time on this one. so i got to tell you, it gives me a lot of hope to hear from your colleagues, as well as to see this committee focusing so intently on this challenge that we're all facing together. i came in to this knowing very little about addiction. but i was just listening to vermonters, much like senator leahy has as he travels around the sta and the heartbreaking stories. i started asking how did we get into this mess, and what do we do to get out of it. when i started talking to the addicts, to law enforcement, to docs, nurses, prevention folks, i learned that we were doing almost everything wrong. almost everything wrong. why? first, our criminal justice system was designed to do -- to maximize addicts going to prison and not going to treatment. just plain and simple. i learned that the most likely chance you have to move someone
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from denial -- and denial with this addiction is extraordinary. it makes denial for alcoholism or the other addictions that we all face with our family an friends look small. but the most likely chance you're going to get to get an opiate addict to agree that they've got a problem and go to treatment is that moment when the blue lights are flashing, the handcuffs are on and they've bottomed out. what i found was that in vermont, we were missing that opportunity every single time. it took four or five months between getting charged and going before the judge to wind your way through a court system. by then you were back using, back ausing, you were back addicted, you were back doing crime in the streets to feed their habit. so we moved to a rapid intervention system where i literally fund for every state's attorney in our state -- the state funds an assessor, third party assessor, who every time there is a bust goes in and
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makes the determination, is this person someone we should be scared of, in which case they go through the old system, and end up most likely in jail, or is this someone that we should have hope for, get into treatment, and move back to a productive life. all i can tell you is it is working. we are finding the vast majority of folks who are suffering from this disease won't hurt you, they'll just hurt themselves. we're moving them to treatment, to recovery, to a comprehensive hub and spoke system. not that there aren't failures, not that they don't have set-backs, but that actually moves them into recovery. it has reduced our incarceration population dramatically. vermont saved $50 million in the last several years not locking folks up, but instead getting them into the treatment programs and back into a productive life. and it is working as well as one might hope. second, we've expanded treatment like mad.
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and even with tough budget times, we've made tough choices, but we're building out our treatment centers as fast as we can. that, too, is having a huge effect. our problem is that thas we hav removed the stigma, as you are helping to do right here in this hearing today, mr. claire, hair have more and more folks willing to come forward and say i've got the disease, i need help. we literally are finding longer and longer waiting lines because there's more demand. but we have to keep building out treatment centers and we need help in building out those treatment centers. third, the rescue kits that your colleagues mentioned about the narcan is absolutely critical. we were the first state to get into state police and law enforcement hands, into the hands of firefighters. we've saved hundreds and hundreds of lives. this is expensive stuff. we need help saving lives.
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prescription drug monitoring program that senator shaheen has mentioned that she wants to build upon is critical. we've had governors from all over new england working together to improve the data where folks are shopping for prescription drugs across state lines. so without telling you more about what i think we're doing right and what's giving me hope, i want to mention a little bit about what isn't giving me so much hope. listen, we need financial help. the states cannot do this alone. as an example, when senator leahy helped to get us a grant for $3 million, it seems like a small amount of money in washington but it was huge for vermont in allowing us to get it to the howard center, to actually help us build out our treatment centers. we're scraping together pennies to try and make our treatment centers stand on their own. so financial help from
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washington is critical. i am encouraged by the bipartisan support here in the senate to help us get the financial resources that every state needs to fight this battle and to win it. so money, huge. second, we've got to look at what's holding us back in treatment. one of the things i got to tell you that i found in vermont is that as we build out our treatment centers, particularly this is true in small rural states, where we're having challenges getting enough primary care docs in the medical field to deal with the illnesses that we're all facing, with the medicaid and medicare underpayments and so forth, we do not have an extra physician force to deal with the magnitude of treatment that is necessary to successful win this crisis. to get treatment to folks that need it. so you got to ask this question -- and this is a federal change that i beg you to make -- why is it that physician assistants and nurse
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practitioners can prescribe oxycontin and other drugs that lead to heroin addiction, but they can't prescribe the treatment drugs that would allow someone to get off this stuff and back in normal life? why is that? so i ask you to help us in expanding the force on the ground that will help us actually be able to treat folks by making it immediately possible for physician assistants and nurse practitioners under the direction of physicians to be able to prescribe the maintenance drugs that allow us to move from addiction. i just can't to close by saying this. we do need to ask this question -- why are we in this mess? what led us into this mess? why are all 50 states, on a bipartisan basis, saying we need help? this is everybody that's having this problem. this disease knows no racial
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boundaries. it knows no income boundaries. it knows no partisan boundaries. everybody's in. and i think we have to have a more honest discussion about what led us into this mess. listen, i know that our instinct is to say, wow, those folks down in south america and other places are sending us lots of heroin and it's a huge problem. well, of course it is. but i ask you, is that a new problem? has something changed dramatically in the last decade or so that has brought this heroin to america? and i would say, no. we've always had this problem of drug dealers trying to get -- support their countries and their wars and everything else by sending illegal drugs to america. so then what did change? i think it is important for us to have an honest conversation about this. what changed was that we changed
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our attitudes in america and our practices in america in the late 1990s about how we deal with pain. why aren't we talking about that? listen, this i can tell you. i have a lot of hope for where we are headed. i am incredibly discouraged that we still have people signing up for opiate addiction in vermont than we had when we launched this battle two years ago. well, why? listen, the facts matter. when the fda approved oxycontin, purdue several years later, the manufacture of that drug, pleaded guilty to telling physicians and docs that this painkiller wasn't addictive. they paid a $60 million who are $70 million fine in the same year that $11 billion worth of oxycontin and other painkillers were sold in america. listen, these facts matter. in 2010, we prescribed enough oxycontin in this country to
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keep every adult in america high for a month. we did. those are just facts. in 2012, we prescribed 250 million prescriptions of oxycontin. that's only last time i checked, roughly 250 million people in our country, so that's a prescription for every living american. just a few years ago, the fda approves xohydro. i call that oxycontin on steroids. we're about to do this all over again, team. and when they approved that, they didn't maic it tamper resistant so you can snort it or shoot it. that's what led us into this mess. just this year they approved oxycontin for kids. i mean you cannot make this stuff up! so, i ask us to pause, to take a deep breath, and to ask this
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question -- are we willing to have aen honest conversation about the way we're dealing with pain medication in america? because i can tell you that until we do, all the good work that we're trying to do together will lead to more tragedy, more loss of life, more of our sons and daughters dying of opiate addiction, because that is what has changed. what has changed is that we simply pass out painkillers like candy in america and we're unwilling to have that conversation. thank you. >> senator leahy. >> mr. chairman, i assume our senate colleagues probably have to leave. i've seen the senate's schedule. it is not the house schedule but the senate schedule is pretty busy. i'd ask that they -- the senators be excused. but i do have a question for the
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governor. >> if you want to go, go. i don't have questions for you. we can talk anytime and i look forward to continued conversation on this legislation with my colleagues. so you can stay new want to. go ahead, ask governor shumlin your question. >> governor, you and i have talked about this a lot, and i appreciate your passion. i would note for everybody here, this is not just something that the governor says publicly. he's talked about it a lot privately. and i think it is fair to say, you feel the same way that i've heard from police officers all over the state of vermont. it's not just a law enforcement problem. i think a lot of them certainly tell me, both at the federal level police, state police, local police, county, they tell
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me if they could get people into treatment, they'd much prefer doing that. is that the same thing you're hearing? >> absolutely. i got to say that law enforcement has been extraordinary ally in this battle. i know this is true not only in vermont but across the country. i was recently on a panel with a police chief in gloucester, massachusetts, who literally said, listen, here's my policy. and now new hampshire and vermont law enforcement folks are doing exactly the same thing. if you're addicted to opiates, come to my station. we won't arrest you. we'll get you into treatment. we'll get you into recovery. we're not arresting any more folks who are addicted to this disease and are non-violent. i sometimes think we don't give law enforcement enough credit for being on the front lines of this. for years we said to law enforcement as a nation, this is your problem, go settle it. if i were law enforcement, i'd be a little raw about that. but instead they've said, hey,
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we want to partner with the medical community and the treatment folks, partner with the judiciary, partner with families to try and solve this problem as a disease, not a crime. and without them, we would not be where we are. >> but we also have to have a place where they can bring these people. if we're going to have a diversion program, i think we'd all agree, you got to then have the people there. >> absolutely. we're literally scraping together th resource resources and pull this off. vermont, i bet you any of the senators from new hampshire and iowa would say the same thing -- we're not there yet but we are doing the best we can with the resources we have. >> senator grassley mentioned to me, nurse practitioners. >> i think we ought to follow up. we have a lot of -- you know, nurses, the attitude towards nurses in america is you can't have a nurse until you got a doctor looking over you. we got to change that.
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but in rural america we have to make greater use of nurse practitione practitioners. >> i'm somewhat partial to nurses, as you know, and have a daughter-in-law that's an active nurse practitioner. >> i want to thank my colleagues for coming. i've done roundtables around illinois. there's no town too small, no suburb too wealthy not to have heroin overdose deaths in the state of illinois. i want to especially thank governor shumlin because i think you pointed to something we need to point to. we can all endorse the legislation that's been prescribed. every single piece of it i look at and think, i'm for that. you go to the heart of our responsibility. the food and drug administration. the pharma industry. the dirty docs. we don't have to go to the border here to see the source of opioids. you go to the pain clinic in the mall. you go to the doctor just around the corner. you go to the pharmacist who
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looks the other way. and clearly i think we have responsibility here. pharma is making a fortune off this. now i'll concede the fact that over the last ten years, we have decided to tackle pain directly. i'm glad. for a lot of people, it is the difference in quality of life that we have to readily acknowledge. but with it has come a dramatic abuse. to think that the prescriptions, legally written prescriptions in this country, result in a bottle of pills for every single adult american. as you said, to treat them with this drug for at least a month tells me it's out of control. congress, what are you doing about this? senate, what are you doing about this? and the fda dreaming up new applications for children? and for super opioids? where in the heck is the congress in terms of our
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responsibility when it comes to this? the second point i'd like to make is that police chief in gloucester ought to be here today because dixon, illinois, population 20,000 went to visit with him and decided after four heroin overdose deaths in one weekend, they were going to buy into his program. 25 kids came forward. young people came forward. you know what happened? they went into treatment. and you know what happened to the jail? it was empty. the petty crimes, the burglaries, the thefts to sustain these habits started disappearing. but there's a key element here. how did they get into treatment? if they're lucky enough, if they're lucky enough to have health insurance, and their families have access, if they're lucky enough through the affordable care act to have access to medicaid, then they get into treatment. and we all know we don't have enough resources here to treat these people. we absolutely, positively have to do it. i want to commend, too, we have
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senators from minnesota here. it was senator wellstone and senator domenici in a bipartisan effort that demanded, and finally after years, succeeded in bringing reform to health insurance so that it now covers mental health counseling. it now covers addiction services. those who want to repeal the affordable care act put your hand up if you want to repeal that part of it. it would be disastrous atrcross america when we consider this drug overdose and other things. thank you for really turning the spotlight back on us. it's not just all the things we've heard. we've got to look at fda, pharma, we've got to look at what's going on with the illicit prescription and filling of prescriptions across america. that is our responsibility. thank you. >> i'll call on cornyn, then whitehouse. >> i just want to take a second to thank you our colleagues for your powerful presentation here today. i think what we're seeing in america is that we're
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reconsidering a lot of our criminal justice policies. this committee's under the leadership of chairman grassley, has passed out, for example, a criminal justice reform bill. something i know that senator portman and others have worked on a lot. but i hope that we, as we look at this terrible pandemic, as senator shaheen called it, we look at this comprehensively. because i don't know if you can draw any artificial lines between dealing with mental health issues in the criminal justice system, drug addiction issues, because we know from talking to our sheriffs that many of our jails are populated by people with mental health issues for which they self-medicate if they are unable to find other places where they can get some help. but i would also like to make a me of my colleagues on behalf of somebody that represents a state with 1,200 miles of common border with mexico.
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demand is a big problem, governor. thank you for your powerful testimony. but we also need to deal with the supply issue as well. i know it's tough. our friends in mexico say, well, we wouldn't have all the drug cartel activity and all the transportation of drugs into the united states if there wasn't such demand in the united states. so we do have to deal with both of those. but i hope as we look at this, we won't draw any artificial lines or create any stovepipes and we'll try to find a way to deal with this in a broader, more deliberate sort of way. thank you. >> senator whitehouse. >> mr. chairman, i'll put my statement in the record so we don't go on too great length. we have two panels ahead of us still. but while senators portman and ayotte are here, i want to thank you them for it the terrific work they did as original co-authors of the c.a.r.a. bill. senator klobuchar and i are very grateful, they were joined by
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other senators very early on in the proceeding so i thank them but i also want to particularly thank senator hatch and senator graham who were the first two committee sponsors on the majority side for this bill. they've helped make sure that we have this hearing today. i want to just make a record of how important senator hatch and senator graham have been to getting us to this point. in addition, of course, to the chairman himself who made the call. so thank you very much and whatever else, i'll add to the record. >> senator tillis, then senator klobuchar. >> thank you, mr. chair. to my colleagues, thank you for being here. thank you for your work on this. senator ayotte, as i've already expressed to you, a special thanks to you wearing carolina panthers black and blue today after your patriots got eliminated. governor -- [ laughter ] i think it's a great step. look forward to seeing it moved through the process. >> it is.
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>> governor, i had a question for you. i am a personal friend of your speaker. i've known him for about five years, having been speaker down in north carolina. to the point that senator cornyn is making -- and i do agree to a large extent with what senator durbin said. but if we focus on, for example, the prescribed painkiller problem, then i think we're going to see an increased uptick in heroin abuse. it is obvious it's happened in north carolina. as a matter of state policy, we did a number of things to crack down on drug shopping and the sorts of things we were seeing in the state. there is almost a direct correlation between a reduction in those prescribed opioids and an increase in heroin abuse. so as a matter of state policy, what are you all looking at? i'm also very struck by the fact that some states, there are great disparities between
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overdoses and deaths. i was shocked to know that ours had gone up 480% over three years, but it is still a fraction of what a state that's gone 1.5 million people has versus a state that has 10 million people. what are we doing to address these specific issues and what risk do we want of federal policy p potentially hampering what you and your senator leader need to do to address things that are unique to some of these states that seem to have disproportionate problems? >> that's a great question, senator. i can't tell you why some states are being hit harder than others. but this, i'm convinced of -- i don't think that we would have the heroin problem in america if we weren't starting folks out on opiates that are sold over the drugstore counters. it just isn't coincidence that
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our irrational exuberance around painkillers isn't maxed by the crisis. if we went back to the old policies on pain medicine, when somebody has pain, treat it and treat it hard, but don't pass this stuff out as if it is not a problem, which is what we're doing. i'll give you an example. i know we can all tell these stories but the other day a reporter came into my office. she just had surgery for carpal tunnel or whater we all call it. i said w many do you get? she said what did you mean? i said how maoxis did you get? she said 80. i said how many do you take? she said half of way. >> there's 79 1/2 left behind. next week daughter of a colleague comes by, four molars pulled out. i said what did they give you
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for painkillers? oxi. i said how many did you get? she said 40. i said how many did you take? she said none. so there's 40 mr. my point is, there a he no question when we made it tamper resistant folks went to the pure heroin because it is cheaper around it is easy to get. but, we cannot lose sight of the fact that we were not having this problem prior to the invention of oxycontin. we just weren't. we've got to go back to the source. i think as the senator from illinois said el kwebt oquently listen. i mentioned xohydro. when the fda approved it, its own advisory panel, 13 members voted 11-2. fda, do not approve this drug. they did. so my point is, there is a correlation if you talk to folks who are addicts, which i've
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done. and many, many times, 89% of the time, folks say to me i got in a car accident, i had surgery, this happened to me, knee, whatever it was. that led me into this mess. >> senator shaheen wanted to add something. >> i did. i think we've talked about the fda. everybody here has talked about pharma and the role of prescription drugs. what we haven't really talked about is medical schools and doctors. it's my understanding that most medical schools don't have any courses on prescribing medication, on recognizing drug abuse. seems to me we've also got to get some attention from medical schools who are turning out doctors who are doing these prescribing practices without the history of what's been raised here at this hearing. >> amen. >> senator ayotte? >> i certainly fully agree with senator shaheen on this. we have to fully engage the medical community on this. for example, back in new
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hampshire, back when i was attorney general we were fighting for are prescription monitoring them and our state was late to the game. because when we look at this data in giving physicians information that they can have -- that's one of the pieces ever this c.a.r.a. bill -- physicians that want to do the right thing gives them the data to understand if someone's doctor shopping. it also gives us the focus to know if a particular doctor is actually exceeding his or her bounds because it's all focusing on them. so that allows us to address that. but we have to engage the medical community. i think you'll hear, some of the work samsa has done nationally, 4 out of 5 people started with overusing or misusing prescription drugs. to your point, chairman, that you raised in your opening, we also right now with a patient survey are actually encouraging reimbursement based on how satisfied people are with pain. and that has to be addressed as well. i know that cms is looking at this but it has to be a
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priority. because we don't -- this was brought to our attention from doctors who are concerned that if they're worried about an addiction issue, they're being judged on a survey that's saying how -- how is your pain satisfaction? so that has to be addressed as well. >> senator portman, then senator klobuchar. >> quickly, mr. chairman, i don't disagree with the comments made here. as a result, in this legislation we not only have the drug monitoring programs which are incentivized, and to the question of how the states will respond to this legislation, it doesn't mandate states to do this. it does provide incentives. some states have done some cutting-edge work and they should be the laboratories of democracy in this but we are helping them on this prescription monitoring program, including across state lines. in our states we may have a great program. my state of ohio, southern ohio, west virginia and kentucky have different problems. that's something that the federal government can exclusively do. we have legislation on that.
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second, this drug take-back program sin sentive i tiveis in legislation. final thing i'll say is that having talked to hundreds of people who are recovering, who have been addicts because of prescription drugs, i understand that issue very well, including the athlete i talked about earlier. but i will tell you also a lot of people i have talked to jumped that step and went straight to heroin. holly is an example of that as we'll hear about later from her mom. i think now, because heroin is so plentiful, i was just with the fbi in ohio, yesterday, talking about this. the drug cartels from mexico are in ohio. they're in illinois. they're in our states. because it is so plentiful, because it is so cheap, it is not just about prescription drugs anymore. it has been a gateway for a lot of people, but now there is a problem. we have directly with heroin.
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even first use. back in the days when we worked on this issue of cocaine and marijuana back in the '90s, hair whip was not a first-use drug. it was a drug that you used after you had other gateway drugs typically. with young people as young as 13, 14, 15 years old, they are using heroin to today. so this legislation is comprehensive. it does deal with the prescription side but it also deals directly with the heroin issue which, sadly, we now have to confront, perhaps because of this onslaught that came from the overuse of pain medication. but now the heroin is upon us. >> senator klobuchar. >> thank you very much, mr. chairman. i am proud to be original co-sponsor to this bill. i just want to say -- get to this point about what we should really be looking at here and what we have some control over in the congress. i'm a former prosecutor. i know that these drugs have been coming in, as you've stated, senator portman. but i think the number one thing that we can do right now, in addition to funding our law
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enforcement, making sure we have efforts with dea funding, is really go after what's been happening with prescription drugs. because while it is true that there are people that originally get hooked on heroin, the facts are the facts, as senator ayotte just said. 4 out of 5 -- that's 80% -- this is the last statistic i had. 4 out of 5 of these heroin users started with prescription drugs. what the governor's been telling us and senator durbin's been telling us, this is different than it was even when i started as a prosecutor in 1998. this is a different situation. we have these prescription drugs. i bet everyone in this room either has some in their cabinet, has had some in their cabinet or knows someone in their family where you just took one or two as the governor pointed out, and there's 20 left. or there's 30 left. and they are sitting in there. senator cornyn and i passed a prescription drug take-back law years ago. we finally got the rules out of dea so we could get that moving. but that is not going to solve it if it just keeps happening
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over and over again. in this bill, the would, that senator ayotte and i did on prescription drug monitoring. but just having come from a state here where we're not just the land of 10,000 lakes but 10,000 treatment centers, the l treatment centers the home of hazelton and betty ford. i know talking from the doctors and experts we'll not really change it until we change the way the painkillers are given out and that's why the doctor monitoring, the having more limited of dipension of these kind of drugs is going to make the biggest difference here, because i am all in on trying to do everything we can to keep these dangerous drugs out of our towns. but the change here and what we have more control over is how we get these people hooked on drugs in the first place and sometimes they are such innocents. they just have a bad back, and no one warns them that given their particular makeup if they take these drugs for four days instead of maybe just one day or maybe just one, they're actually going to get hooked. we are doing this in our
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country. our policy, not a drug dealer on the corner, so that's what i think we need to focus on and that's why i'm pleased with this bill. >> senator sessions? >> i think senator klobuchar is correct. there was an important point that a reporter with "the new york times" has written an online book say these pills delay healing, the pain pills. the more you take, the longer you have these problems and he had a lot of points that we really need to reduce the amount of prescription drugs out there. as a former prosecutor myself, we targeted prescription drugs in mobile, alabama, that most -- it can be the most successful reduction of drugs there is, because they're not many sources. only certain doctors were way over the list. we found really the illegality was coming from drugstores, two drugstores. so, when you eliminate that, you don't plea bargain with people until they tell you where they got their pills, you can pretty
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quickly go right back to the sources that are out there. it's a winnable thing and it does lead to additional drug use, so thank you, mr. chairman. >> senator kuehnes? >> thank you, chairman grassley and ranking member leahy. i hope the american people notice the striking bipartisan this panel has shown. the questions and comments we've heard from the members of the judiciary committee and the input from the senators who worked on this issue for a long time. my home state is also struggling with an opioid addiction challenge tha has translated quickly into a heroin epidemic that has penetrated every level of society and every background and i, too, have stories we could share about our local law enforcement and paramedic and first responder community. i'm thrilled to be able to support the bipartisan bill that lays out the authorizing background for expanding prevention and supporting recovery and senator shaheen's
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emergency supplement to make sure we have the legal framework and the financial resources. this is a genuine problem in all of our states and it's my hope that folks watching recognize you've got republicans and democrats working together to craft a thoughtful, broad strategy. it's my real hope we will get these bills moved. thank you, mr. chairman. thank you, members of the panel. >> we've had a forceful discussion, very seldom do our colleagues get involved with questions from their colleagues, and thank you all very much for your patience. i'm going to move on to the second panel now. and i -- i know that i don't have to tell you that we'll be talking about this in the future because you're going to make sure we do. >> thanks. >> the second -- while we have commotion, i'm going to call the second panel. our first witness is michael botticelli, director the national drug control policy at the white house. as director he heads the obama administration drug policy efforts and is responsible for
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creating the annual national drug control strategy. previously he served as director of substance abuse services, massachusetts. he has an undergraduate degree from sienna college and a masters of education st. lawrence university. second witness dr. nora volkoff director of the national institute of drug abuse which supports most of the world's research on health aspects of drug abuse addiction. previously she worked at the department of energy's brookhan national laboratory where she held several leadership positions. she earned her medical degree at the national university of mexico. our third witness, she serves as the acting administrator substance abuse mental health services administration. that agency leads public health efforts to advance the behavioral health in our
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country. she has worked at samhsa since 1998. earned a bachelor's degree and a master's degree in psychology from ucla and is also a graduate of harvard kennedy school government. our final witness is louie melahoney, deputy assistant administrator, office of division and control within the drug enforcement agency. in that position he's responsible for overseeing and coordinating major pharmaceutical and chemical division investigations, drafting and promulgating regulations. he's been with the dea in multiple capacities since 1997 and holds a b.a. from villanova university and j.d. rutgers. we will go with the way that we introduced you, so, would you please start out and you appear
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before our committee many times. thank you for returning. >> great. thank you, chairman grassley. members of the committee, thank you for the opportunity to be here today to discuss the issue surrounding opioid drugs including heroin and fentanyl in the united states in our response. as you know, this is an important issue for president obama. during his state of the union address earlier this month, the president specifically mentioned addressing prescription drug use and heroin as a priority. and an opportunity to work with congress on an issue that transcends party, income level, gender, and race. i also want to thank many members who are here today in the support of our office on this most pressing public health and public safety issue. the office of national drug control policy produces the national drug control strategy which is our blueprint for drug policy. using our role as coordinator of federal drug control agencies, in 2011 the administration released a plan to address the sharp rise in prescription
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opioid drug use. this plan contains action items categorized in four areas. many discussed today. education of subscribers and patients and increased of prescription drug monitoring programs, proper drug disposal and law enforcement efforts. since this plan was released this crisis has clearly evolved. with an increase in heroin and fentanyl use and overdose deaths and the administration has put forward new initiatives to help deal with emerging issues. as all of you know and indicated, we need a comprehensive and multifaceted response and coordination at the feder federal, state and local levels. opioids are taking a horrific toll on public health in safety in countries across the united states. we all talked about the stagger numbers so i won't repeat them here. these numbers are harrowing, however, but we are making some progress in addressing prescription drug misuse. past month nonmedical use of opioids by americans 12 and
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older was significantly lower in 2014 during its peak in 2009. the number of people initiating nonmedical use of prescription pain med -- relievers in the past year also decreased significantly. this progress, however, has been counteracted by an increase in the availability and use of heroin, although nonmedical prescription opioid use continues to far surpass heroin use. heroin purity has been rising while prices have remained low. and this heroin crisis has been compounded by the reemergence of elicit fentanyl a powerful synthetic opioid that is sometimes added to heroin to increase its potency or used on its own. since fentanyl is far more potent than heroin, it has increased risk and increased overdose death in the united states. although the transition from nonmedical prescription opioid use to heroin occurs at a very low rate, a recent article concluded that this transition appears to be part of the progression of the disorder among those with frequent
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nonmedical prescription opioid use or dependence. we've all talked about the need for enhanced possibler education and graduate medical education programs because they do not provide on comprehensive focus on identification and treatment of opioid use or safe and effectieffect opioid prescribing. one of the most jarring studies recent evaluation of health care claims data found that a majority of nonfatal opioid overdose victims were receiving an opioid from a prescriber at the time of their overdose and most alarming 91% received an opioid prescription again from a prescriber. 70% of them from their own prescriber before an overdose. in response, last year president obama issued a presidential memorandum requiring all federal agencies to the extent permitted by law to provide training on the appropriate and effective prescription of opioid
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medications for their staff who prescribe controlled substances. the administration also continues to press and would continue to work with congress to pass mandatory possibler education tied to control substance licensure. the administration has focused on several areas. including educating the public on overdose risks and interventions, increasing third party and first responder access to the onaloxone. we appreciate the congress provided more than $400 million in funding in the fy-'16 appropriation act specifically to address this epidemic an increase of more than $100 million from 2015. to address the emerging rise in heroin and fentanyl use our 2015 strategy foc

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